Presented by: Niramya Pathak MD
MPUH: Muljibhai Patel Urological Hospital, Nadiad, India

Introduction

To compare the dusting versus fragmentation modes with Thulium fibre laser (TFL) in Retrograde Intrarenal Surgery (RIRS) for upper tract stones using the same fixed low power laser settings in both the arms. Primary objective was to compare stone free rate and secondary objectives were to compare mean operating times, hospital stay duration, complication rates, need for secondary procedures, and laser efficacy.

Materials

A prospective randomised trial, with patients having proximal ureteral or renal stones of 10-20 mm size and planned for RIRS was done at a single institute. Total of 60 consecutively admitted patients with signed consent were included for randomization with 30 patients in each arm of dusting and fragmentation modes.

Results

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Median age in dusting and fragmentation arms were 41.5 and 45.5 years, median stone sizes were 10.45 and 12.25 mm, median stone volume was 351.6 and 490.7 mm³ and median stone density of 1263.5 HU in both arms. Median hospital stay duration was of 2 days in both arms. Lasing time was significantly lesser in the Fragmentation group (20.5 min, IQR 15.12-31.62) than in dusting group (34.25 min, IQR 26.62-38.62), p <0.001. Higher ablation speed for fragmentation mode (0.405 mm³/sec, IQR 0.337-0.635) than dusting mode (0.17 mm³/sec, IQR 0.135-0.325), p <0.001. Stone free rates and complication rates were comparable in both the arms.

Conclusion

TFL in fragmentation mode has shorter lasing times and better laser efficacy than dusting mode with comparable minimal complications, stone free rates and hospital stay duration.

Funding

None

Co-Authors

Nishanth Gowda, MD
MPUH: Muljibhai Patel Urological Hospital, Nadiad, India

Vijay Victor, MD
MPUH: Muljibhai Patel Urological Hospital, Nadiad, India

Abhishek Singh, MD
MPUH: Muljibhai Patel Urological Hospital, Nadiad, India

Arvind Ganpule, MD
MPUH: Muljibhai Patel Urological Hospital, Nadiad, India

Ravindra Sabnis, MD
MPUH: Muljibhai Patel Urological Hospital, Nadiad, India

Mahesh Desai, MD
MPUH: Muljibhai Patel Urological Hospital, Nadiad, India